Friday, April 27, 2012

Weekly Overseas Health IT Links - 28th April, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Hospitals with electronic health records (EHRs) barely earn a passing grade when it comes to following best practices in treating heart failure and pneumonia, according to an audit by a clinical decision support content provider.

Only 62% of hospitals' EHRs included clinical processes that have been proven to reduce congestive heart failure patients' mortality, hospital readmissions, and overall costs; 67% included clinical processes for treating pneumonia. That is good for an overall grade of D or D-minus from Los Angeles-based Zynx Health, a unit of Hearst Publishing. Company officials believe the study to be the first of its kind.

In an updated draft of its national action plan for fighting healthcare-associated infections (HAI), the Department of Health and Human Services (HHS) highlights the role of health IT.

"Monitoring and measuring HAIs is a critical component of the overall strategy to prevent and reduce HAIs," the plan[1] says." Advances in information technology (IT), harmonization of disparate data standards, incentive programs designed to promote the meaningful use of electronic health records (EHRs), and capabilities to connect with and integrate multiple data types and sources all provide opportunities to enhance national capacity to monitor, measure, and prevent the occurrence of HAIs."

Continued efforts to use big data in healthcare and make it more widely accessible could play a significant role in lowering overall costs, the authors of a new report[1] published this week argue.

The report--rolled out by the Kansas City, Mo.-based Ewing Marion Kauffman Foundation, which promotes entrepreneurship--makes a number of specific recommendations, including points regarding data use in both patient care and medical research.

Recently, big data has been garnering attention as a potential problem-solver for today's industry woes. But, before jumping into the new "data-driven paradigm" of leveraging big data, a recent report by CSC suggests organizations take a look at their basic, data-centered strategy.

"Most organizations have more data to work with than they realize, but they need to recognize the challenges and plan to overcome them," the report reads. "For example, the data landscape is constantly changing. The size, scope, and types of data available are rapidly evolving, and so are the tools needed to make sense of it all. To identify competitive advantages and achieve better command and control over their data, entrepreneurial healthcare executives need to recognize this evolution."

In the largest collaborative study of the brain to date, scientists using imaging technology at more than 100 centers worldwide have for the first time zeroed in on genes that they agree play a role in intelligence and memory.

Scientists working to understand the biology of brain function — and especially those using brain imaging, a blunt tool — have been badly stalled. But the new work, involving more than 200 scientists, lays out a strategy for breaking the logjam. The findings appear in a series of papers published online Sunday in the journal Nature Genetics.

Personal and health information for about 315,000 patients is missing, Emory Healthcare announced Wednesday. The hospital system has been unable to find 10 computer discs containing the data.

The missing discs held information on all patients who had surgery at Emory University Hospital, Emory University Hospital Midtown and The Emory Clinic Ambulatory Surgery Center between September 1990 and April 2007. The discs contained protected health information, including patient names, along with the diagnosis, the name of the surgical procedure and the surgeon. Approximately 228,000 of the patient records also included Social Security numbers.

"The combination of a highly mobile device like the iPad, and comprehensive patient data spanning many hospitals through ClinicalConnect, brings effective, fast, secure and safe decision-making ability right to the bedside at any time, day or night," said Dr. Rafi Setrak, emergency physician, Niagara Health System.

EHRs can wreak havoc on a practitioner's clinical documentation of patient care, exposing the provider to malpractice claims, warns HIT author Ron Sterling, in an article[1] posted on hitechanswers.net.

"Regardless of the legitimacy of care and treatment, the inappropriate use of EHRs and/or EHR design vulnerabilities are exposing physicians to questions on the quality of care and physician due diligence," he writes.

Another is a series of studies on what drives EHR implementation and use has found Meaningful Use incentives are driving adoption among primary care physicians.

A whopping 95 percent of respondents reported that they're adopting EHRs to achieve Meaningful Use. Meanwhile, 53 percent said they were doing it to improve patient quality of care, according to a survey[1] conducted by modermedicine.com.

Cost savings are always key drivers of new initiatives. And in today's healthcare industry, as priorities continue to shift and pressure is added to increase revenues and improve outcomes, one element could be a key player in making it all happen: big data.

"We think it's going to separate winners from losers in many markets over the next five years," said Russ Richmond, MD, CEO of healthcare solutions and consulting company Objective Health. "The institutions that are capable of first understanding where the market is going … are going to have tremendous advantages over the ones who can't or won't do this. We believe that over time, it's going to become a core competency for hospitals, and it won't be something seen as extra or nice to have – it's going to become a core part of how they operate going forward."

This is the expanded version of a piece that appears in the May 7, 2012 issue of Forbes Magazine.

More than 6,500 guests gathered in an overflowing auditorium at the Intergalactic Headquarters of Epic Systems this past September. The campus, nestled on 800 acres of farmland in tiny Verona Wis., was the site of an annual event for customers. The theme: “Once Upon A Time.” To loud applause, a dark-haired woman dressed in leather chaps with a bandana tied around her head strode on stage, where a Harley-Davidson a.k.a. gooseneck awaited. The modern-day Mother Goose in this fairy tale was Judith Faulkner–simply known as Judy in the health care galaxy, living up to her motto: “Do good, have fun, make money.”

She has made a fistful. From her remote midwestern outpost, Faulkner, 68, has quietly built Epic, which sells electronic health records into a $1.2 billion (2011 revenues) business—double four years ago. She has done it without outside capital, and no marketing. She remains the company’s single largest shareholder, rebuffing an attempt by her biggest client health care giant Kaiser Permanente to get a piece of equity, when Epic was much smaller. The company won’t disclose earnings, but says it’s profitable, and proudly proclaims to have zero debt. By next year, 127 million patients or nearly 40% of the U.S. population will have its medical information stored in an Epic digital record. Helping enrich Faulkner is also a piece of government legislation that subsidizes the adoption of electronic medical records, by paying millions to qualifying hospitals. (See Matthew Herper‘s story on Cerner here).

The role of privacy officer has changed since it was mandated in 2003 by HIPAA. New regulations, technology and data-sharing initiatives have reshaped the landscape, according to Chris Dimick, staff writer for Journal of AHIMA, who outlined the new role of the privacy officer in the April edition.

“Protecting patient health information has become much more complex since 2003, when nearly all healthcare organizations used time-tested systems to protect paper records,” Dimick wrote. “In turn privacy officers now require an expanding set of knowledge and skills, and as regulatory pressures and technological initiatives have advanced, their roles have grown in strategic importance within their organization.”

A recent report from Global Data pegged the global mHealth market as having a $500 million value in 2010 that will top $8 billion by 2018. The research firm argues that the rise of mobile health has been partially encouraged by the global financial crisis, which led to a focus on finding cost efficiencies in the system in addition to improved outcomes and quality of care.

“Despite years of discussion and promises,” KLAS reports that fewer than 10 providers in the country are doing EMR integration with their smart pump vendors, even though over half consider it key to future pump selection.

Report author Coray Tate commented, “Providers are looking at EMR integration as the next big step to make infusions safer. Drug libraries catch most errors, but mistakes can still be made.”

Demand for healthcare information by patients and clinicians will help drive the business need for health information exchanges, according to Dr. Farzad Mostashari, national health IT coordinator. Clinicians and patients should ask for or seek relevant patient information whenever and wherever healthcare decisions are made. Mostashari's timely comments put a spotlight on the role of patient advocacy in care coordination and how that advocacy intersects and enriches health information exchange.

Used in a meaningful way by healthcare providers, health IT should help lower the cost of care, while improving the quality of care, patient satisfaction and the patient-provider relationship. Health IT in the form of personal health records or data-capturing devices for patients ideally should help them be knowledgeable of and manage their conditions. It should also empower them to be their own advocates in this complex healthcare environment. This is an ideal world and goals that the industry is trying to achieve.

BALTIMORE – The number of physicians using electronic health records has doubled over the past two years, Doug Fridsma, MD, told an audience at AHIMA's ICD-10 Summit Monday.

“We are making real progress on EHR adoption and we are developing a workforce that is beginning to be trained to support this progress,” said Fridsma, director of the Office of Standards and Interoperability, part of the Office of the National Coordinator for Health Information Technology (ONC).

An onslaught of mobile health technology has forced an arranged marriage between smartphone app makers and the Food and Drug Administration — because someone had to regulate them.

There’s just one problem: Many of the tech wizards aren’t used to FDA supervision. And now, both sides are struggling to figure out how to live with each other.

Last year, the FDA suggested some ground rules: If you make an app that claims to diagnose or treat a medical condition, then you need to show that it’s safe and effective before you sell it, just as other medical-device makers do.

As social media continues to grow as a communications medium, so too does its impact in healthcare. According to a report[1] published today by consulting firm PwC, patients increasingly are turning to social media sites such as Facebook and Twitter both to find and share medical information. What's more, of 1,060 surveyed consumers, 45 percent said that information obtained via social media could impact their decision to get a second opinion.

Researchers working at Purdue University and Princeton University have developed a proof-of-concept device, called MedMon, that blocks hackers from hijacking or interfering with wireless medical devices, like pacemakers, insulin pumps, or brain implants. The researchers were motivated to work on the problem after discovering how easy it was for hackers to break into current wireless medical systems.

The researchers believe that hundreds of thousands of people using wireless insulin pumps or wireless-enabled pacemakers are currently vulnerable. Other devices, not yet in the market, like brain implants that manage epilepsy and “smart prosthetics” could also be hacked. Despite the potential for hacking, the researchers admit the chances that any given would be hacked is low.

Doctors and other ER staff are constantly waiting too — waiting to see if the X-Ray report is available, waiting to see whether lab results are back and waiting to see whether medication that was ordered was given to the patient.

And the only way to know whether any of this information is available is to go into each patient’s medical record individually and do a check. Repeat the same process for every patient that’s in the ER.

But Dr. Vernon Smith at the Mayo Clinic has come up with a real-time dashboard that is meant to take away all this repeated checking. It incorporates easy-to-understand icons — X for an X-ray, a drop of blood to represent lab results and mortar and pestle for medications – that are displayed on large computer screens throughout the emergency department.

By Associated Press, Published: April 16

Express Scripts aims to help patients stay on their meds with a product that predicts who will stop taking prescriptions before the person actually does it.

The pharmacy benefits manager is launching ScreenRx, a program that uses a computer to sift through hundreds of factors that affect patients and forecast who is most likely to forget a refill or simply stop taking their drugs. The company then plans to contact those patients to help them stick with their doctor’s orders.

Express Scripts executives say their new program is focused on a big target.

Researchers from Indiana University and the Indianapolis-based Regenstrief Institute have developed an automated system aimed at helping enable pediatricians focus on the specific health needs of each patient in the short time allotted for preventive care. The systems comes on the heels of a new study, “Automated Primary Care Screening in Pediatric Waiting Rooms,” in the May 2012 issue of Pediatrics which found personalizing and automating the patient screening process and then alerting the physician to positive results of risk factors enables them to direct attention to the particular needs of the individual child and the child’s family.

The automated system created by the Indiana University and Regenstrief researchers, called the Child Health Improvement through Computer Automation System (CHICA), aims to do exactly that.

Cheryl Clark, for HealthLeaders Media, April 17, 2012

When something goes wrong after robotic surgery with the da Vinci surgical system, it's most likely due to co-morbidities in certain patients that make the procedure riskier, not flaws in the robot's technology itself, according to a study of 884 surgeries published this week in the Archives of Surgery.

"After reviewing all these cases, we can say for sure that there is no specific morbidity connected with the robot by itself, and that its mechanical failure is very, very rare," says lead author Pier C. Giulianotti, MD, of the Division of General and Minimally Invasive Surgery at the University of Illinois at Chicago. "We can now say that the morbidity and mortality that occurred in these patients was connected to the risk factors in the patients."

The authors wrote that by understanding which patients are at greater risk for robotic surgery complications, surgeons eventually can develop a scoring system to measure quality of care among providers and hospitals.

OREM, UT – Thousands of urgent care centers are looking for an EMR to adapt to increasing patient volume, and providers are finding success with three different types of EMRs, according to a new report from research firm KLAS.

Of the more than 9,000 estimated urgent care centers, many report plans to increase in size or location in the next 12 months. Many need an EMR.

Patient-centered care is the mantra of the movement to reform the nation's healthcare delivery system. According to this credo, patients must be able to obtain copies of their medical records and visit summaries; they should have personal health records that they can share with their providers; they should have "patient-centered medical homes"; they should share in medical decision making; and, of course, the security and privacy of their personal health information must be rigorously protected.

All of this makes sense, both for the individual and for the healthcare system. Since about 90 percent of healthcare is self care, consumers must be involved--and must, in some cases, change their health behavior--to become healthier and reduce the overall cost of care. "Patient engagement" is also a key component of accountable care organizations, because ACOs' success depends on keeping patients healthy and out of expensive care settings. Only by educating patients and enlisting their cooperation can ACOs generate savings and remain within their budgets.

Our GP columnist would like a Star Cops-style personal assistant. Or failing that, some agreed definitions of data and a decent dashboard to display them on.

3 April 2012

Did you ever watch Star Cops in the late 80s? I don’t really remember any of the plots; just that it involved a policeman solving crimes on the moon accompanied by his amazing PDA.

He would simply talk to this marvellous device and it would wirelessly access loads of other computers and databases and find out things for him, drawing conclusions and unearthing clues based on very little input.

I’m pretty certain that this led me to buy a Psion and numerous other PDAs since, most of which haven’t lived up to the dream. It wasn’t until a few months ago, when Apple demoed Siri, that the fantasy almost became reality.

BEAVERTON, OR – Hoping to drive more "plug-and-play" connectivity of personal health technologies, Continua Health Alliance has made available its most recent design guidelines as a free download for device vendors.

The design guidelines, called Adrenaline, aim to help technology developers build end-to-end systems more efficiently and cost-effectively by facilitating connectivity between personal connected health products such as smartphones, gateways and remote monitoring devices. They were previously available only to Continua members during interoperability testing.

Health-care players are finding that crunching the numbers can pay off in both better care and lower costs

Under pressure to do more with less, insurers, pharmacy benefit managers and health-care providers are all pushing data analysis to new heights.

Insurers have been crunching numbers for years to figure out which patients are most likely to generate high costs. Now other groups are gauging probabilities of relapses, and the likelihood of a patient's not taking his or her medicine. Using models that draw on massive troves of medical and other data, some are also focusing on seemingly healthy individuals, trying to prevent problems before they occur.

Several insurers, including UnitedHealth Group Inc. and WellPoint Inc., are seeking to pinpoint who will develop conditions such as diabetes. Pharmacy-benefit managers such as Express Scripts Inc. and CVS Caremark Corp. are working on programs to predict medication compliance. Care providers, meanwhile, are trying to identify who is most likely to be admitted—or readmitted—to a hospital, and are adjusting their care to prevent such return visits.

(Reuters) - Baby boomers wired to their iPads and smart phones are giving U.S. health experts some new ideas about ways to cut the soaring costs of medical care in graying America.

Some of the ideas might sound like "Robo-Granny". An astronautical engineer at the Massachusetts Institute of Technology has made a skin-tight undersuit equipped with sensors that can constantly monitor the vital signs of its elderly wearer and feed the data into a computer that fires off health alerts. It was first designed for a landing on Mars.

There's also Paro, the robotic seal which has fur, big eyes and responds to voice commands, a low-cost companion that the AgeLab at MIT is testing to help calm elderly people with dementia. Then there is the magic carpet with a built-in sensor that monitors gait to check for risk of falling.

Other ideas are simpler and already are being tested by governments and private health insurers. Marilyn Yeats, 79, is suffering from congestive heart failure and uses a personal healthcare computer, Connect, provided by the health insurer Humana Corp. She calls it My Little Nurse for helping her keep track of her blood pressure, weight, temperature and whether she is taking her medicines on time.

How powerful is the electronic medical record? Practice Fusion will stretch the EMR’s muscles over the next year as it tries to incorporate patient-friendly tools and make the product more social. Think one part Yelp and another part Facebook with a dash of telemedicine.

On Sunday night the company will launch a physician review portal built on feedback in surveys from the patients of doctors using Practice Fusion’s Web-based electronic medical records system. Then later this week the company will release ChartShare, which will allow doctors in and out of Practice Fusion’s network to chat with one another similar to using Facebook chat (except it’s HIPAA compliant).

The Department of Health recently announced Dame Fiona Caldicott’s independent review into the protection of patient data. This announcement comes in response to the NHS Future Forum’s recommendation that the balance of patient protection and sharing of patient data needs to be addressed.

The last major review of the security of patient information occurred in 1997. Since then, there have been significant changes in the use and deployment of EHRs.

NHS is also undergoing a transformation in which electronic healthcare will become fundamental to every aspect of patient care. The radical reorganization of the NHS in England is giving local healthcare providers even more responsibility for their own EHRs, and for ensuring they are secure.